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Emergency department mortality: Fair and square.

M Saban1, H Patito1, L Zaretsky1

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Summary
This summary is machine-generated.

Therapeutic decisions for end-of-life (EOL) patients in the emergency department (ED) are influenced by patient traits, staff factors, and ED conditions. Patient characteristics were found to be the most critical determinant in choosing life-extending treatment (LET) versus allowing natural death (AND).

Keywords:
Allow natural deathEmergency departmentEnd of lifeLife-extending treatmentMortality

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Area of Science:

  • Medical Ethics
  • Emergency Medicine
  • Palliative Care

Background:

  • End-of-life (EOL) care decisions in the emergency department (ED) are complex and influenced by multiple factors.
  • Understanding the determinants of life-extending treatment (LET) versus allowing natural death (AND) is crucial for improving EOL care.
  • Previous research has not fully elucidated the interplay between patient characteristics, medical staff variables, and ED setting in EOL treatment decisions.

Purpose of the Study:

  • To explore therapeutic approaches for EOL patients in the ED.
  • To examine if decisions for LET or AND are dependent on patient characteristics, medical staff variables, and ED setting.
  • To identify key factors influencing EOL treatment choices in the emergency department.

Main Methods:

  • Retrospective archive study conducted in a tertiary hospital's ED from January 2015 to December 2017.
  • Analysis of data from 674 EOL patients who died in the ED.
  • Collected data included dying process (LET vs. AND), patient characteristics, ED-setting variables, and medical-staff characteristics.

Main Results:

  • The proportion of EOL patients receiving LET increased from 18.1% in 2015 to 30.3% in 2017.
  • Male patients were more likely to receive LET than females.
  • Patient characteristics were the most crucial contributors to therapeutic approach decisions (C statistic 0.624-0.675).

Conclusions:

  • Therapeutic approaches for EOL patients in the ED are influenced by patient, medical staff, and ED setting variables.
  • Patient characteristics play the most significant role in determining LET versus AND decisions.
  • Development of national programs is recommended to ensure unbiased EOL decision-making.